title: Practice of central nervous system prophylaxis and treatment in acute leukemias in Spain. Prospective registry study.
abstract: OBJECTIVE
  Central nervous system (CNS) involvement in patients diagnosed with acute leukemias (AL) is an uncommon complication with poor prognosis. The indication and the schedules of prophylaxis and treatment of CNS involvement in AL are not homogenous among countries and within the same country. The aim of this prospective longitudinal study was to analyze and report the practice of CNS prophylaxis and treatment in patients with AL in Spain.
  
  
  METHODS
  Prospective study conducted from June 2005 to June 2006. Adult patients (> or = 18 yr.) diagnosed with AL who received CNS prophylaxis or treatment were consecutively included through online registration.
  
  
  RESULTS
  265 patients from 32 hospitals were included. Mean (standard deviation) age was 44 (16) yr. and 133 (50%) were males. For acute lymphoblastic leukemia patients (n = 158), CNS therapy was given to 12 cases (10 at diagnosis and 2 at relapse) and consisted of triple intrathecal therapy (TIT, methotrexate, cytarabine and hydrocortisone) in 11 and liposomal depot cytarabine in one. CNS prophylaxis (n = 146) consisted of TIT in 135 cases, intrathecal methotrexate in 7, intrathecal cytarabine in 2 and intrathecal liposomal depot cytarabine in 2. No cranial irradiation either for prophylaxis or therapy was given in any case. In acute myeloblastic leukemia patients (n = 107), CNS therapy was administered to 17 cases (9 at diagnosis and 8 at relapse). Intrathecal therapy consisted of TIT in 11, intrathecal liposomal depot cytarabine in 5 and intrathecal cytarabine in one. One patient also received craniospinal irradiation. CNS prophylaxis (n = 90) consisted of TIT in 68 cases and intrathecal methotrexate in 22.
  
  
  CONCLUSIONS
  In Spain, the patterns of CNS prophylaxis and therapy for AL are homogeneous. TIT was the most frequent schedule for CNS prophylaxis and therapy. The lack of use of cranial or craniospinal irradiation and the administration of new drugs (i.e.: liposomal depot cytarabine) for CNS therapy and prophylaxis is of note.
authors.affiliation: Servicio de Hematología Clínica, ICO-Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
authors.forename: Juan-Manuel
authors.initials: JM
authors.lastname: Sancho
authors.forename: Mireia
authors.initials: M
authors.lastname: Morgades
authors.forename: Reyes
authors.initials: R
authors.lastname: Arranz
authors.forename: Pascual
authors.initials: P
authors.lastname: Fernández-Abellán
authors.forename: Guillermo
authors.initials: G
authors.lastname: Deben
authors.forename: Natalia
authors.initials: N
authors.lastname: Alonso
authors.forename: Margarita
authors.initials: M
authors.lastname: Blanes
authors.forename: María José
authors.initials: MJ
authors.lastname: Rodríguez
authors.forename: Concepción
authors.initials: C
authors.lastname: Nicolás
authors.forename: Eva
authors.initials: E
authors.lastname: Sánchez
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández de Sevilla
authors.forename: Eulogio
authors.initials: E
authors.lastname: Conde
authors.forename: Josep-Maria
authors.initials: JM
authors.lastname: Ribera
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000517:prevention & control*; D003561:Cytarabine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D007278:Injections, Spinal; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008081:Liposomes; D008137:Longitudinal Studies; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D012042:Registries; D013030:Spain
chemical_list: D000893:Anti-Inflammatory Agents; D000964:Antimetabolites, Antineoplastic; D008081:Liposomes; D003561:Cytarabine; D006854:Hydrocortisone; D008727:Methotrexate